A0422 - Acute Renal Failure and Post-ERCP Complications: A Nationwide Inpatient Sample Database Analysis

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Vincent Wong, MD

Rutgers New Jersey Medical School
Newark, NJ

Vincent Wong, MD, Anjella Manoharan, MS, MD, Ahmed Ahmed, DO, Faiz Afridi, MD, Sushil Ahlawat, MD
Rutgers New Jersey Medical School, Newark, NJ

Introduction: Acute renal failure (ARF) occurs when there is recent kidney injury. The insult can stem from an inflammatory response, which can be seen in pancreaticobiliary diseases. Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic and therapeutic tool for diseases affecting the pancreas and biliary tract. End stage renal disease is known to increase the risks of post-ERCP complications but there is a lack of evidence evaluating the relationship between ARF and post-ERCP complications.

Methods: The National Inpatient Sample database was used to identify patients over 18 years old who had an ERCP procedure between 2007 - 2017 using ICD9 and ICD10 codes. Patients were divided into two groups: those with and without ARF. Primary outcomes were length of stay, payor status, and total charges. Secondary outcomes were rates of post-ERCP pancreatitis, cholangitis, cholecystitis, infection, hemorrhage, perforation, and overall mortality. Patients were matched by age, race, sex, and Elixhauser comorbidity index (ECI). Chi-squared tests compared categorical data and independent t-tests compared continuous data. Multivariate analyses were performed to assess secondary outcomes.

Results: Of 413,517 total patients, 206,893 had ARF. For both groups, 56.6% were males, and the majority of the patients were White. The ECI was 14.8 in ARF group vs 12.7 in control group. Patients with ARF were older (70.4 years old vs 70.2, p< 0.001), had longer length of stay (12.1 days vs 7.5 days, p< 0.001), payor status with most patients having Medicare (p< 0.001), and higher average total charges ($130,844 vs $80,935, p< 0.001). Secondary outcomes were significant (p< 0.001) for pancreatitis (OR 2.0), perforation (OR 1.9), cholangitis (OR 2.8), cholecystitis (OR 3.2), infection (OR 4.4), hemorrhage (OR 3.3), and mortality (OR 4.9).

Discussion: Acute renal failure is seen in severely ill patients, which is demonstrated by an increased ECI, length of stay, and average total charges. These patients may be slightly older and have Medicare. In ARF, elevated blood urea nitrogen and creatinine may lead to falsely elevated mortality scores especially in post-ERCP pancreatitis, leading to inappropriate management. ARF is also an immunocompromised state that can lead to increased rates of post-ERCP infection, cholangitis, cholecystitis, perforation, hemorrhage, and mortality. Further studies are needed to look into other scoring systems that can better predict morbidity and mortality in patients with ARF.

	Odds Ratio (95% CI)	P-Value
Post-ERCP Pancreatitis	2.0 (1.8-2.2)	< 0.001
Post-ERCP Perforation	1.9 (1.5-2.4)	< 0.001
Post-ERCP Cholangitis	2.8 (2.4-3.1)	< 0.001
Post-ERCP Cholecystitis	3.2 (2.5-4.1)	< 0.001
Post-ERCP Infection	4.4 (4.1-4.7)	< 0.001
Post-ERCP Hemorrhage	3.3 (2.7-4.1)	< 0.001
Mortality	4.9 (4.7-5.1)	< 0.001

Table: Clinical Outcomes of Patients with Acute Renal Failure who Underwent Endoscopic Retrograde Cholangiopancreatography (ERCP). CI = Confidence Interval

Disclosures:

Vincent Wong indicated no relevant financial relationships.

Anjella Manoharan indicated no relevant financial relationships.

Ahmed Ahmed indicated no relevant financial relationships.

Faiz Afridi indicated no relevant financial relationships.

Sushil Ahlawat indicated no relevant financial relationships.

Vincent Wong, MD, Anjella Manoharan, MS, MD, Ahmed Ahmed, DO, Faiz Afridi, MD, Sushil Ahlawat, MD. A0422 - Acute Renal Failure and Post-ERCP Complications: A Nationwide Inpatient Sample Database Analysis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.